- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.06 / $39.32 / $49.09
| Professional | | $38.06 | $39.32 | $49.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.68 / $11.25 / $13.64
| Professional | 26 | $10.68 | $11.25 | $13.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.39 / $28.07 / $35.43
| Professional | TC | $27.39 | $28.07 | $35.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.72 / $64.72 / $64.72
| Facility | 26 | $64.72 | $64.72 | $64.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.44 / $61.81 / $176.03
| Professional | | $52.44 | $61.81 | $176.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.05 / $16.55 / $43.74
| Professional | 26 | $14.05 | $16.55 | $43.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.04 / $37.04 / $37.04
| Professional | TC | $37.04 | $37.04 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.38 / $59.90 / $176.03
| Professional | | $49.38 | $59.90 | $176.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.23 / $15.54 / $43.74
| Professional | 26 | $14.23 | $15.54 | $43.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.82 / $38.86 / $64.53
| Professional | TC | $33.82 | $38.86 | $64.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.95 / $56.37 / $176.03
| Professional | | $47.95 | $56.37 | $176.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.68 / $15.54 / $43.74
| Professional | 26 | $14.68 | $15.54 | $43.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.27 / $36.34 / $64.53
| Professional | TC | $33.27 | $36.34 | $64.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.40 / $55.01 / $151.38
| Professional | | $38.40 | $55.01 | $151.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.55 / $14.70 / $42.83
| Professional | 26 | $11.55 | $14.70 | $42.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.43 / $38.72 / $140.72
| Professional | TC | $27.43 | $38.72 | $140.72 |